The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

IMPLEMENTING AN EVIDENCE-BASED, OUTCOMES DRIVEN, INTERDISCIPLINARY TEAM IN A RURAL, CRITICAL ACCESS HOSPITAL: THE IMPACT ON INHALED BRONCHODILATOR OUTCOMES

Kimberly J. Bennion1, Carri Aguiar1, Julie Ballard2, Segura Ezra1, Ludlow Michele1, Michelle Colledge1, Jenny Chambers1; 1Heber Valley Respiratory Care, Intermountain Healthcare, Heber, UT; 2System Improvement, Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, UT

Introduction: Heber Valley Medical Center (HVMC) is a 19-bed critical access hospital of the Intermountain Healthcare Corporation. With limited nursing resources, leadership piloted the use of a Respiratory Therapy (RT) department to implement evidence-based guidelines (EBG) & educate medical/ nursing staffs. EBGs are medical executive committee approved & allow RTs to tailor care plans per patient (pt) response. One EBG introduced to medical & nursing staffs was inhaled bronchodilator delivery. The EBG includes the documentation of pre- & post-treatment (tx) breath sounds (BS) & peak flows (PF) which are utilized to evaluate efficacy of tx & determination of care plans. Prior to RT implementation, all RT txs were performed by nursing. As of February 1, 2008, RTs were scheduled from 0700-1900 daily, 3 night shifts per week (1900-0700) & on-call for the remaining 4 nights. RTs use a pre-printed progress note to document daily assessments of pts ordered on txs. The pre-printed note reports txs ordered, txs delivered, pt response & suggested care plans. We sought to compare 2007 (pre-RT) to 2008 (post-RT) bronchodilator outcomes to determine what if any impact the RT department contributed. Method: Comparison data of all 2007 & 2008 pts ordered on an inhaled bronchodilator (ie: Xopenex, Albuterol and/or Atrovent) were identified. Inclusion criteria were pts with at least 1 inhaled bronchodilator tx ordered. Initially, 211 pts were identified. Of these, 55 charts were unavailable which left us 156 (74%) of the total pts for final review. Results: Outcomes are reported in Tables One. Discussion: When comparing the documentation of PF & BS, a statistically significant improvement with p < 0.05 was noted post implementation of a RT department. PF & BS should be documented pre- & post-bronchodilator tx but were performed less frequently by nursing than RT. EBG revision is planned to include the measure of FEV<1> as a determinant of tx efficacy. Bronchodilator care plans on the night shift (1900-0700) were followed less than on the day shift (0700-1900)with documentation as to why txs were not given rarely being noted. Processes for improvement were identified & are being implemented to improve pt outcomes & to enhance interdisciplinary adherence to the EBG. It is our impression that the addition of a RT department with education, an EBG & outcomes reporting improved inhaled bronchodilator guideline compliance when comparing 2007 to 2008. Sponsored Research - None.

Table One: 2007 & 2008 HVMC Bronchodilator Treatments With Peak Flow & Breath Sound Documentation

*Meeting Peak Flow criteria = age > 5 years and patient able to perform/coordinate peak flow maneuver

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